<div class="delivery_form">
	<hr class="hr_dashed" />
	<form class="delivery_option">
		<p><input type="checkbox" class="checkbox" /> <span>Don't send my bill via Post <em>(waive itemised bill charge)</em></span></p>
		<p><input type="checkbox" class="checkbox" /> <span>Send my bill via Email <em>(optional)</em></span></p>
		<p><input type="checkbox" class="checkbox" /> <span>Send my bill notification via SMS <em>(optional)</em></span></p>
		<p><input type="checkbox" class="checkbox" /> <span>I have read this <a href="#" class="click_notice">Notice</a> <em>(you must check this to get your chosen bill delivery options)</em></span></p>
		<p><span class="error">Error message</span></p>
		<div class="marginauto width80">
			<p><label>My Email</label><input /><br />
				<span class="error">Error message</span></p>
			<p><label>My Mobile No</label><input class="small" /><input class="medium" /><br />
				<span class="error">Error message</span></p>
		</div>
		<div class="clear"></div>
		<div class="align-center"><input type="submit" class="btn" value="Submit" /></div>
	</form>
</div>
<div class="clear"></div>
<div class="delivery_notice">
	<div class="clear"></div>
	<hr class="hr_dashed" />
	<p>All request for 'DON'T SEND MY BILL VIA POST' or official bill statement to be sent to your emailing address must be submitted no later than 48 hours before the date of your official bill statement. Request made on or after the date of your official bill statement will be applicable for the following month's official bill statement.</p>
	<p>In the event you do not receive your official bill statement, please:</p>
	<ol>
		<li>Log on to Maxis Online Account website and view your official bill statement on-line; or.</li>
		<li>Contact our Customer Service at 1800 821 123 or dial 123 from your Maxis mobile for assistance. If you are abroad, dial _603 749 22123.</li>
		<li>I / We hereby agrees that this service subscribed herein shall form part of the Services ( as defined in the Agreement ) and further agree to be bound by the terms and conditions of the Agreement</li>
	</ol>
	<div class="align-center"><input type="button" class="btn close_notice" value="Back" /></div>
</div>



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